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Court Gives Final Approval to a Settlement Agreement That Saves California's Adult Day Health Care Services


Read Settlement Agreement (PDF)

A court approved the terms of a settlement agreement in a class action lawsuit, Darling v. Douglas, that challenged California's elimination of Adult Day Health Care (ADHC) as a Medicaid optional benefit. AARP Foundation Litigation attorneys, in conjunction with attorneys from Disability Rights California, National Senior Citizens Law Center, National Health Law Program and the firm of Morrison & Foerster LLP, represented the plaintiffs.

The settlement ensures that critical community based services will be preserved, helping low income seniors and people with disabilities to avoid unnecessary hospitalization or institutionalization. Esther Darling, 74, lead plaintiff in the case, said, "There are a lot of people who really need this program; I have fought to stay out of a nursing home and have been able to with ADHC."

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The settlement agreement resolved the lawsuit that had been filed initially by elderly individuals with disabilities seeking to stop cuts to ADHC services enacted by the legislature. Then in March 2011, over the very strong opposition of AARP California, the legislature voted to eliminate ADHC as an optional Medi-Cal (as Medicaid in California is known) benefit. ADHC is a Medi-Cal funded community-based program for low-income elderly and disabled adults designed to support individuals who live at home or in licensed residential care facilities to avoid unnecessary hospitalization or placement in nursing homes or other institutions. Many people who depend on ADHC services have family caregivers who would be unable to continue to support their loved one at home without the medical monitoring, therapy and other supports they receive at the center.

Plaintiffs sought to block the elimination of ADHC unless adequate replacement services were in place, asserting that the elimination would place them at risk of unnecessary institutionalization and violate their rights under the federal Americans with Disabilities Act (ADA), Rehabilitation Act, Medicaid Act, the due process clause of the U.S. Constitution and state laws.

Twice before, the court issued preliminary injunctions to halt proposed cuts because they placed people at risk of institutionalization in nursing facilities and hospitals and was about to hear a third request for an injunction when the case settled. The now approved settlement covers the entire case and the state's appeal of the second injunction to the U.S. Circuit Court of Appeals will be withdrawn.

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Under the settlement, 35,000 ADHC participants will be re-assessed for eligibility and transitioned into the newly created Medi-Cal funded program (called Community-Based Adult Services or CBAS). Many ADHC providers will be given the opportunity to apply to become CBAS providers. ADHC participants found not to be eligible for CBAS will receive Enhanced Case Management to assist their transition to community-based services. CBAS will begin on March 1, 2012.

What's at Stake

Medi-Cal is the main source of health care insurance for more than 7 million Californians. The closely watched ADHC dispute protected the civil rights of people who sought to avoid institutionalization, instead seeking the support to be able to age in the place they call home.

Case Status

On Jan. 24, 2012, the U.S. District Court for the Northern District of California, after commending all the parties for working diligently to resolution, approved the settlement in Darling v. Douglas (C:09-03798 SBA).

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Watch the Highlights

Thanks to the support of our donors and partners in 2022, we helped older adults with low income secure more than $726 million in new income, benefits, refunds, and credits.